Guided Study Questions Respiratory 729 2023.docx

729 2023 Guided Reading Questions for Respiratory Assessment Identify three functions of the upper airway. Conduit for inhalation and exhalation of air Warming and humidification of inspired gases via nasopharynx and posterior pharynx Tissue hydration and trapping of pathogens via mucous membranes I...

729 2023 Guided Reading Questions for Respiratory Assessment Identify three functions of the upper airway. Conduit for inhalation and exhalation of air Warming and humidification of inspired gases via nasopharynx and posterior pharynx Tissue hydration and trapping of pathogens via mucous membranes Identify the primary sources of airways resistance in: Laminar flow: flowing like a smooth line to allow for efficient gas exchange – resistance reflects the viscosity of gas Turbulent flow: flowing chaotically and facilitates trapping of inhaled particulate matter – resistance reflects the density of gas Reynold’s number helps determine whether flow is laminar or turbulent with higher numbers being more turbulent The trachea terminates at carina (bifurcation) Which upper lobe bronchus gives off 3 segmental bronchi? Right upper bronchus – right mainstem is wider and more vertical At which generation do airways lose all cartilage? Level of the bronchioles What effect does the increasing division of airways have on airflow resistance? As divisions increase, resistance decreases due to increased cross sectional area of airways Identify the three types of alveolar cells and their functions: Type 1 squamous epithelial – gas exchange Type 2 produce surfactant Alveolar macrophages – phagocytize foreign objects Functional assessment of the respiratory system should include evaluation of which three functions? Respiratory mechanics, gas exchange, and cardiopulmonary interaction Did you review the Practical Guide to Clinical Medicine: The Lung Exam? Yes – inspection, palpation, percussion, and auscultation List the three lung capacities or volumes not determined by simple spirometry FRC – functional residual capacity (ERV+RV) = volume after normal exhalation TLC – total lung capacity (IRV+TV+FRC) RV – residual volume = volume of air to keep lungs inflated Which three lung volumes are included in vital capacity? VC = Inspiratory reserve volume + TV + Expiratory reserve volume The most useful test of alveolar gas exchange is diffusion capacity for carbon monoxide CO has high affinity for Hgb so it follows the same path as oxygen to bind with hemoglobin Post thoracotomy patients are at risk for poorer post-thoracotomy outcomes if their VO2 max is < 15 mL/kg/min VO2max is most useful predictor of post-thoracotomy outcome What physical test correlates well with VO2 max? 6 minute walk test What percentage of URI’s are due to viral or bacterial nasopharyngitis? URI = upper respiratory infection – 95% Symptoms of an upper respiratory infection include non-productive cough, sneezing, rhinorrhea Children experiencing an upper respiratory infection are at increased risk for transient hypoxemia and wheezing What are the four risk factors associated with upper respiratory infection that increase the frequency of adverse events under anesthesia? Fever, purulent rhinitis, productive cough, and rhonchi After upper respiratory infection how long might it take for airway hyperreactivity to resolve? 6+ weeks When providing anesthesia care for a patient with an upper airway infection, what three strategies might reduce the risk of adverse airway events? Adequate hydration, reduction of secretions, and avoidance of manipulating airway List the three features characterizing asthma. Chronic airway inflammation characterized by variable expiratory airflow limitation with SOB, chest tightness, and cough (wheezing is common but not specific to asthma) When interviewing a patient with a history of asthma, what 5 things should you be certain to inquire about the patient’s respiratory history? Recent exacerbations/ER visits Sx e.g. SOB, chest tightness, cough Medication use and effectiveness Exercise tolerance Experience with anesthesia Name the three classes of medications an asthma patient may be taking. Inhaled/oral steroids Beta2 agonists Antibiotics List five exposures likely to be associated with provoking COPD. Smoking, environmental pollutants, chronic infections, longstanding asthma, alpha1 antitrypsin deficiency What measures are typically used to assess the severity of COPD? FEV1 = forced expiratory volume = amount of air that a person can force out of their lungs in 1 second… so if you can force out a lot of air in a short amount of time, then you’re airway isn’t obstructed FVC = forced vital capacity = total amount of air that a person can force out Severity based on spirometry in pts with a FEV1/FVC ratio of 0.7 or less Mild FEV1>80% Moderate 80%>FEV1>50% Severe 50%>FEV1>30% Very severe FEV1<30% What change in functional residual capacity typically occurs with COPD and why? FRC is increased due to reduction in airflow, lost elasticity, and overexpansion Further testing, including arterial blood gases, are indicated when a COPD patient is hypoxic or requires supplemental O2 Why is the diffusing capacity for carbon monoxide often reduced by COPD? Airway resistance causes gas to be exchanged less efficiently leading to an overall reduction in diffusion capacity List three extrapulmonary causes of restrictive pulmonary disease. Chest wall abnormalities, muscle/neuromuscular dysfunction, pleural disease List four pulmonary causes of restrictive pulmonary disease. Idiopathic interstitial pneumonia, lung resection, pulmonary fibrosis, interstitial lung disease due to connective tissue disease How does the FEV1/FVC ratio in restrictive disease compare to that of a normal patient? Relatively normal although both volumes are reduced Desaturation on induction and emergence in the obese patient is likely due to decrease in FRC Atelectasis can be reduced by the application of PEEP during anesthesia in morbidly obese patients. List 4 risk factors for obstructive sleep apnea. Snoring, daytime sleepiness, hypertension, obesity, family hx What does the Apnea-Hypopnea Index measure? Number of apneic-hypopneic episodes/hour of sleep Which three airway management tasks may be more difficult in the patient with obstructive sleep apnea? Mask ventilation, direct laryngoscopy, ET placement List the six adverse post-operative events likely to occur in patients with obstructive sleep apnea. Perioperative airway obstruction, hypoxemia, atelectasis, ischemia, pneumonia, and delayed discharge What two parameters define the existence of pulmonary hypertension? Mean PAP >25 mmHg or PAOP>15 mmHg List 5 events which can increase the risk of right heart failure in the pulmonary hypertension patient. Hypoxia, hypercarbia, administration of vasoconstrictors, increased sympathetic tone, increased PVR What percent of patients carrying a diagnosis of pulmonary hypertension experience dyspnea? 60% What clinical event is suggestive of severe pulmonary hypertension? Pre-syncopal or syncopal episodes Identify 4 EKG changes commonly associated with pulmonary hypertension. Right axis deviation, RBBB, RVH, tall R waves in V1-V2, peaked p waves in inferior leads Which non-invasive diagnostic test will identify valvular disorders, right ventricular function abnormalities and left ventricular failure in pulmonary hypertensive patients? EKG List 5 complications of tobacco smoking. Decreased macrophage function Impairment of coronary blood flow – ischemia Vascular endothelial dysfunction Hypertension Wound infection Respiratory complications Ideally, how long before surgery should cessation of smoking occur? 3-4 weeks prior to surgery List four benefits of smoking cessation. Lowered CO levels, levels of toxic substances (better wound healing) cyanide levels (improved mitochondrial oxidative metabolism) Vascular relaxation (due to decreased nicotine) The four common causes of dyspnea are: Disease – cardiac, pulmonary, hematologic, neuromuscular Describe Schamroth’s sign. What are the implications of this physical sign? Occurs in finger clubbing, when this window is obliterated and the distal angle formed by the two nails becomes wider Can indicate underlying systemic disorders such as chronic hypoxia